"The new proposed rule [1] updates MHPAEA terms and definitions; [2] prohibits plans from relying on any factor or evidentiary standard that discriminates against Mental Health benefits in applying and developing NQTLs; [3] further clarifies the types of data that a plan must collect in conducting its comparative analysis; [4] identifies what plans need to include in the NQTL reviews they have to provide to federal regulators; and [5] expressly applies MHPAEA parity standards to non-federal governmental health plans."  MORE >>

"[If] finalized as currently contemplated, all provisions ... would apply on the first day of the first plan year beginning on or after January 1, 2025.... [T]he proposed rules introduce a new framework for determining whether a plan or issuer has designed and implemented an NQTL that imposes greater limits on access to mental health and substance use disorder benefits as compared to medical/surgical benefits.... [T]he data collection requirement includes specific details about network composition ... The proposed rules set out standards for what a comparative analysis must include to satisfy the statutory requirements of MHPAEA."  MORE >>

"Many of the substantive changes and proposed additions to the regulations focus on increasing access to MH/SUD benefits, in part, through measuring, evaluating, and adjusting for outcomes that result when administering benefits and paying claims. The approach goes a step further than prior agency regulatory interpretations and guidance on the significance of outcomes when assessing MHPAEA compliance.... A question raised by this new enforcement approach ... is whether ERISA Section 712 can and should be read to so closely tie the legal requirements of the parity law to access. "  MORE >>

"[T]he No Surprises Act has an impact on the maximum-out-of-pocket limit for annual cost-sharing under the [ACA] ... [FAQs Part 60] sheds light on how these laws interact. Ensuring that insurers and third-party administrators process these claims correctly is even more important given that plaintiff-side law firms have reportedly been advertising online to solicit health plan participants as potential plaintiffs for emerging health plan excessive fee cases."  MORE >>

"The IRS has released draft 2023 forms for reporting under Internal Revenue Code (Code) Sections 6055 and 6056.... No major substantive changes were made to the draft forms for 2023 reporting. However, the IRS still may make certain changes once these forms are finalized or when draft or final instructions are released. In addition, note that the deadline for furnishing statements to individuals has been permanently extended, and beginning next year, most employers must now file electronically."  MORE >>

"The first item to consider is whether you are using the monthly measurement method or the look-back method for benefits eligibility ... Employees should also continue to be measured in their existing measurement period, and any subsequent qualification of benefits should be honored for the duration of the upcoming stability period.... If you have a plan that requires cancellation of coverage due to furlough or reduction in hours, you should be aware of two potential penalties to avoid. The first relates to the affordability of COBRA coverage and the second to your failing to offer coverage."  MORE >>

"More than half the states have enacted PBM laws in the last three years -- some of which specifically impact group health plans, such as Colorado, Oregon, New Mexico, Florida, North Carolina, and Oklahoma. [This article outlines] the most common provisions in these laws that could impact plans, using laws in Oklahoma, North Carolina and Florida as examples of state laws that have been adopted or are being considered by state legislatures."  MORE >>

"The law bans anti-competitive contracting provisions, including: [1] Anti-tiering clauses that require a health plan to extend preferred value tier status to all facilities in a health system. [2] Anti-steering clauses that prohibit insurers from using incentives to direct patients to high value providers. [3] 'All-or-nothing' clauses that require health plans to accept all providers in a health care system. [4] Gag clauses that prevent the parties from disclosing price, terms, or other relevant information to a third party."  MORE >>

"Insurance company UMR Inc. was sued [July 31] by the [DOL] for allegedly breaching plan documents under [ERISA] by denying certain emergency room claims based solely on diagnosis codes and not the standard established by the [ACA].... The claims are in connection with UMR denying emergency services claims and urinary drug screening claims for thousands of health plan participants[.]" [Su v. UMR, Inc., No. 23-0513 (D. Wis. complaint filed Jul. 31, 2023)]  MORE >>

"The DOL, HHS, and Treasury Department released their annual report to Congress regarding group health plans' and insurance carriers' compliance with [MHPAEA].... None of the initial comparative analyses the agencies received were sufficient to demonstrate compliance, the agencies said.... The investigations are time-consuming and often involve multiple rounds of interviews, depositions, document requests, data requests, and subpoenas. Investigations can take one or more years to complete."  MORE >>

"[1] How do I know if the high deductible health plan (HDHP) is HSA-qualified? ... [2] How do HSA contributions work for non-calendar plan years? ... [3] Are employers responsible for monitoring their employees' HSAs and ensuring that HSA dollars are spent on qualified medical expenses? ... [4] What happens to employer and employee contributions if a participant fails to set up their HSA account? ... [5] In what situations may an employer [recoup] mistaken contributions to an employee's HSA account?"  MORE >>

"Taxpayers will have the option to go paperless for IRS correspondence by 2024 filing season, IRS to achieve paperless processing for all tax returns by filing season 2025."  MORE >>

"[1] Use a multi-channel approach: digital and print benefits communications go hand-in-hand ... [2] Keep empathy at the core of your employee benefits communications ... [3] Use benefits communications [that] both 'push' and 'pull' employees ... [4] Create an easily accessible editorial calendar for year-round benefits communication plan ... [5] Think beyond medical, dental, and vision benefits ... [6] Broaden the conversation on employee wellbeing ... [7] Ask for and act on employee feedback."  MORE >>